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Managing the Side Effects of Ulcerative Colitis Treatment

Drug side effects can be similar to ulcerative colitis symptoms. To decipher one from the other, record changes in how you feel in a diary, and contact your doctor when symptoms seem outside of the norm.

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Most medications have side effects, including those used to treat ulcerative colitis. Some of the side effects of ulcerative colitis treatments are similar to the symptoms of the condition, such as diarrhea or flu-like aches. Be sure to ask your doctor exactly what to expect with a particular medication, and tell him or her about all other medications you may be taking, even aspirin, as they could negatively interact with your colitis treatments.

Ulcerative Colitis: Symptoms or Treatment Side Effects?

Typical symptoms of ulcerative colitis include abdominal pain, fever, joint pain, weight loss, diarrhea, vomiting, and bloody stools. How do you tell the difference between these kinds of symptoms and possible medication side effects? June Breiner, MD, an internist in Lutherville, Md., suggests keeping a diary. Record any changes in how you feel after taking your medication, including your pain level, bowel habits, fever, and any new or unusual symptoms. If your symptoms worsen or changes occur, call your doctor immediately, says Dr. Breiner.

Ulcerative Colitis: Anti-Inflammatory Drug Side Effects

Side effects of anti-inflammatory medications for ulcerative colitis can vary by type of medication. Here are some common potential side effects to specific types of medications:

Aminosalicylates. Almost all of these drugs can cause nausea, headache, stomach upset, and joint pain. Talk to your doctor about the types of side effects to expect, what can be done to alleviate or avoid them, and which ones should be reported right away.

Sulfasalazine (Azulfidine): This drug can cause diarrhea, vomiting, and a loss of appetite; for men, it can result in a decrease in sperm count (this will go back to normal after the medication is stopped). Also, you may be allergic to sulfa drugs without knowing it or develop an allergic reaction over time.

Tell your doctor right away if you have any of these symptoms while taking sulfa drugs for ulcerative colitis: aching joints, fatigue, either extreme paleness or yellowing of the skin, hives or another skin reaction, fever, sore throat, or difficulty swallowing.

Olsalazine (Dipentum): Diarrhea is the most common side effect, but it can be eased by taking the medication with food. Other side effects are blurred vision or dizziness, and joint pain. Tell your doctor right away if you develop chest pain, skin rash, or unusual bruising.

Corticosteroids. These drugs, such as (Deltasone), methylprednisolone (Medrol), and hydrocortisone, often give very fast results, but they have a long list — and a wide variety — of potential side effects that ultimately may outweigh the benefits of long-term use. These include insomnia, osteoporosis (bone-thinning disease), high blood pressure, high blood sugar, increased risk of infection, cataracts, weight gain, acne, and stretch marks.

“The risk of these side effects increases with the dosage amount and the length of time a person takes the drug. If you are on this medication for more than six weeks, you should be monitored by your physician and ophthalmologist,” says Breiner.

To reduce the risk of side effects, options include quickly but carefully tapering off of steroids, taking them every other day, or using suppository or rectal cream forms of the drug rather than oral corticosteroids because the former have fewer side effects.

Ulcerative Colitis: Immune System Suppressant Drug Side Effects

Immunomodulators reduce the activity of the immune system, but in so doing they also lessen the body's ability to combat infection. Be sure to report any signs of infection, including a sore throat, chills, or fever, to your doctor. Also, the Crohn’s and Colitis Foundation of America (CCFA) recommends regular blood tests to check for any problems with your liver, kidneys, and bone marrow — normal blood cell production may be affected while you’re taking some of these medications.

Azathioprine (Imuran, Azasan) and 6-mercaptopurine (Purinethol) have a wide range of side effects, but few are very common. Many are symptoms that seem a lot like the flu, including headache, diarrhea, vomiting, nausea, or just feeling under the weather. Your doctor may have you switch from one to the other to see if you have fewer symptoms. More rare side effects include inflammation of the pancreas and bone marrow suppression — not enough blood cells being produced — which could, in turn, lead to an increased risk of infection.

Cyclosporine A (Sandimmune, Neoral) and tacrolimus (Prograf) can cause rare side effects that involve kidney and liver function; they can also cause high blood pressure so your pressure should be carefully monitored. Other possible side effects range from sleep problems to headache, tingling of the fingers and feet, and increased facial hair.

Ulcerative Colitis: Biologic Therapy Side Effects

Infliximab (Remicade) is a newer therapy that’s very effective in treating ulcerative colitis, but the safety of this treatment must be weighed against possible side effects. These may include injection site reactions, like redness, swelling, or bruising. Because the drug works on your immune system, you may be more susceptible to infection, including a higher risk of serious infections like tuberculosis.

Tell your doctor right away if you develop a fever, flu-like symptoms, or a cough, or feel exhausted. Any of these side effects could indicate a serious infection.

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